MEDICARE: PRISCILLA MARIE SIMMS-ROBERSON ADVANCE ADULT NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	12344	TN

General Provider Information

NPI Number	:	1285792705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA MARIE SIMMS-ROBERSON ADVANCE ADULT NURSE

Provider Business Mailing Address
First Line	:	1949 GUNBARREL RD STE 230
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-3187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3905 HIXSON PIKE STE 103
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-3569
Country	:	US
Telephone Number	:	423-756-1506
Fax Number	:	423-756-1909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	11/14/2017

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